American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

June 2014 ACS Advocate

ISSUE 22

Welcome to the June edition of The ACS Advocate.

While many of you are preparing for your summer vacations, the American College of Surgeons Professional Association’s (ACSPA) political action committee (ACSPA-SurgeonsPAC) is preparing for the upcoming election season. 2014 is an election year for the entire House of Representatives and one-third of the Senate. As you can imagine, many hotly contested races are taking place across the nation, which is why the ACSPA-SurgeonsPAC is constantly working at the federal level on issues that support and promote candidates who will serve as champions for the practice of surgery.

Like it or not, all roads lead through Washington, DC. The decisions made on Capitol Hill have a profound effect on our members’ ability to practice surgery. For some of the most important issues facing surgeons—including the need for medical liability reform, Medicare physician payment reform, increased research funding, trauma care systems funding, and hospital admittance rules—surgeons have the power to influence the process.

In the 2013 ACSPA-SurgeonsPAC annual report, you will find highlights of PAC activities and accomplishments, along with a comprehensive list of 2013 contributors. In 2013, the ACSPA-SurgeonsPAC raised more than $606,000 from nearly 2,000 members and ACS staff. With the help of all 2013 PAC contributors, your College leaders, staff, and engaged Fellows were able to make and maintain critical connections with elected officials. The College’s political clout has never been stronger and the effect of the ACSPA-SurgeonsPAC in Washington, DC, is significant.

You have the ability to help make a noticeable impact in Congress.

Start by using SurgeonsVoice.org, an online resource created specifically for College members. It is an interactive advocacy program that will help you establish critical professional and personal relationships with decision makers, both on and off Capitol Hill. SurgeonsVoice provides guidance on how to host an event in your hometown for members of Congress, how to respond to calls to action, and more.

You may also make your annual contribution to the PAC at www.surgeonspac.org. By joining your colleagues in financially supporting SurgeonsPAC, you are helping to ensure that surgery is in the best possible position to have the greatest positive impact on the upcoming elections and, ultimately, the decisions being made that directly affect the practice of medicine.

Contributions to ACSPA-SurgeonsPAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of the ACSPA have the right to refuse to contribute without reprisal. Federal law prohibits ACSPA-SurgeonsPAC from accepting contributions from foreign nationals. By law, if your contributions are made using a personal check or credit card, ACSPA-SurgeonsPAC may only use your contribution to support candidates in federal elections. All corporate contributions to ACSPA-SurgeonsPAC will be used for educational and administrative fees of ACSPA, and other activities permissible under federal law. Federal law requires ACSPA-SurgeonsPAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. ACSPA-SurgeonsPAC is a program of the ACSPA which is exempt from federal income tax under section 501 (c) (6) of the Internal Revenue Code.

At the Federal Level

Welcome! Drs. Opelka and Bailey Join DAHP Leadership Team

Rare Earth Magnet Recall

The Fight Against Cancer

Biomedical Research Legislation

2015 IPPS Proposed Rule

EHR Hardship Deadline July 1

Dr. Ko Appointed to NQF Surgery Standing Committee

DAHP Recent Activities and Meetings

CODING CORNER: Workshops and ICD Preparedness

At the State Level

Florida Trauma Legislation Nixed

New York Truth in Advertising Legislation

Breast Density Deductible Eliminated in Connecticut

New York Medical Liability Legislation

Limiting Use of Tanning Devices by Minors

Optometry Scope of Practice in Louisiana

Liability Reform in Missouri

Other News of Interest

At the Federal Level

Two Fellows Join DAHP Leadership Team

In June, Frank G. Opelka, MD, FACS, a colorectal surgeon and physician executive, and Patrick V. Bailey, MD, FACS, a pediatric surgeon, will join the Division of Advocacy and Health Policy (DAHP) Leadership Team.

Dr. Opelka, who has worked on a number of College committees as well as with socioeconomic and state and federal health care quality organizations, will serve as the ACS Medical Director of Quality and Health Policy. Dr. Bailey will serve as ACS Medical Director of Advocacy.

Dr. Opelka holds a number of national positions, including ACS Surgical Quality Alliance Chair and American Medical Association Physician Consortium for Performance Improvement Chair. He also plays a leadership role on the National Quality Forum’s (NQF) Consensus Standards Approval Committee and the NQF’s Measure Application Partnership. He is currently executive vice-president of health care and medical education redesign at Louisiana State University System, New Orleans.

Dr. Bailey is chief of pediatric surgery at Maricopa Medical Center in Phoenix, AZ. He currently serves as Vice-Chair of the ACSPA-SurgeonsPAC and is a member of the ACS Health Policy and Advocacy Group. He is completing a master of legal studies degree at Arizona State University’s Sandra Day O’Connor College of Law and is a Captain in the Navy Reserve.

Their offices will be located in the ACS DAHP in Washington, DC.

Rare Earth Magnets Shelved Following Pressure from Medical Community

The Consumer Product Safety Commission (CPSC) on May 12 announced a voluntary recall of two of the most commonly purchased rare earth magnet sets, BuckyBalls and BuckyCubes. These magnets can cause injury when multiple magnets are ingested and attract inside the body, causing obstructions or perforations that frequently require endoscopic retrieval or surgical intervention. Under the terms of the recall, consumers who purchased the potentially dangerous items will be able to return them and receive a refund of the purchase price. Refunds will come from a trust fund controlled by the CPSC and funded by the founder of Maxfield & Oberton, the now defunct company that originally sold the products.

Maxfield & Oberton agreed in late 2012 to discontinue production of these dangerous items due to continued pressure from the medical community, including the ACS, and other concerned parties. Sales of existing stock, however, continued, and the CPSC decided to move forward with the rule-making process and held a hearing on the issue in late 2013. According to the CPSC website it is now illegal under federal law for any person to sell, offer for sale, manufacture, distribute in commerce, or import into the U.S. any BuckyBalls or BuckyCubes magnetic set. Additional recall information is available on the CPSC website.

The Fight Against Cancer

The ACS Commission on Cancer (CoC) provided a statement to the U.S. Senate Special Committee on Aging hearing on The Fight Against Cancer: Challenges, Progress, and Promise. The May 7 hearing was part of an initiative to increase funding for cancer research, specifically to study the correlation between aging and cancer. Panelists said that although survival rates are improving, cancer continues to be the second most common cause of death in the U.S., exceeded only by heart disease, and although it affects all people, regardless of demographic characteristics, it poses particular challenges for older Americans.

ACS advocacy staff and representatives from the National Institutes of Health (NIH) and the National Cancer Institute (NCI) attended the hearing and agree that significant progress has been made, as reflected in the fact that the number of cancer survivors tripled in the last 40 years; however, little still is known about the impact of cancer treatments on the body as it ages. In January, Congress was able to restore $1 billion in funding to the NIH and NCI; nonetheless, their budgets remain far below the funding they received in previous years. The hope is that the hearing is one of the first steps toward filling the funding gap.

The CoC has set comprehensive, patient-centered standards and collects standardized data to measure cancer care quality in approximately 1,500 accredited hospitals in the U.S. and supports initiatives that seek to improve cancer prevention, early detection, cancer care delivery, and outcomes in health care settings.

ACS Supports Biomedical Research Legislation

The ACS supports legislation introduced in both the Senate and House of Representatives in May that, if passed, would provide sustainable support for biomedical research in the U.S. This federally funded revenue stream would enable the NIH, the Centers for Disease Control and Prevention, the Department of Defense Health Program, and the Veterans Medical and Prosthetics Research Program to continue producing scientific innovations aimed at accelerating the discovery, development, and delivery of new patient treatment options.

The end goal is to help Americans live healthier, longer lives while helping the U.S. continue to lead the world in medical innovation. This legislation was introduced just as the 21st Century Cures initiative was unveiled; that program seeks to close the gap between the scientific development of cures and the regulatory pathway to therapies.

2015 IPPS Proposed Rule Would Increase Acute Care Hospital Payments

On April 30, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2015 Inpatient Prospective Payment System (IPPS) proposed rule. The proposal calls for increasing average inpatient payments to acute care hospitals by 1.3 percent in FY 2015, which begins October 1, 2014. This payment update is contingent upon hospitals reporting specified quality data set forth in the Inpatient Quality Reporting Program. The proposed rule also solicits comments on alternative Medicare payment systems for short inpatient stays for conditions that may be treated on an outpatient basis.

In addition, the proposed rule would make a number of changes to CMS quality improvement programs. For example, it calls for increasing the maximum penalty for hospitals with excessive readmissions under the Hospital Readmissions Reduction Program to 3 percent from 2 percent for readmission billings, as well as further reducing hospital Medicare payments to fund the Hospital Value-Based Purchasing program to 1.5 percent from 1.25 percent. The proposed rule also implements recent legislation that delayed implementation of both the two-midnight policy and the International Classification of Disease, 10th revision (ICD-10) conversion.

ACS staff is evaluating these and other provisions in the proposal to determine the impact on surgery and plans to submit a comment letter to CMS. 

Deadline to Apply for EHR Hardship Exemption Is July 1

Penalties loom for eligible professionals (EPs) unable to successfully participate in the CMS Electronic Health Records (EHR) Incentive Program by July 1 and for EPs who participated in calendar year (CY) 2011 or 2012 but could not participate in 2013. These EPs may receive a 1-percent penalty on their total Medicare Part B fee-for-service payment amount in CY 2015.

To avoid the penalty, these EPs should apply for an EHR hardship exception by July 1. If they do not qualify for an exception, they should begin their 90-day reporting by July 1, 2014, and submit any attestation to CMS by October 1, 2014.

Dr. Ko Appointed to NQF Surgery Standing Committee

Nominated by the ACS, Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS, was recently appointed to the NQF Surgery Standing Committee. The committee identifies and endorses performance measures for accountability and quality improvement that address a number of surgical specialty areas, including cardiac, thoracic, vascular, orthopaedic, neurosurgery, urologic, and general surgery.

Dr. Ko, Director of the ACS Division of Research and Optimal Patient Care, oversees all of the College’s quality improvement programs, including those activities conducted through the Committee on Trauma and Commission on Cancer as well as the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, National Accreditation Program for Breast Centers, Surgeon Specific Registry, and ACS National Surgical Quality Improvement Program.

Dr. Ko also has served on many NQF committees, including the Colorectal Cancer Technical Working Group, National Voluntary Consensus Standards for Hospital Care, Surgery and Anesthesia Technical Expert Panel, and Health Care Outcomes Steering Committee. In addition, he was the principal investigator on a study assessing the NQF indicators for cancer.

The NQF is a multi-stakeholder, not-for-profit organization that builds consensus on national priorities and goals for performance improvement, working in partnerships to achieve them; endorses national consensus standards for measuring and publicly reporting on performance; and pursues national goals through education and outreach programs.

Recent DAHP Activities and Meetings

  • State and legislative staff participated in a meeting with the U.S. Veterans Administration (VA) to discuss a proposed VA nursing handbook that would consist of revised and new practicing guidelines for advanced practice nurses, including certified registered nurse anesthetists.
  • Regulatory staff participated in a CMS eHealth Summit webinar on May 19. Among others, participants heard from the Center for Medicare & Medicaid Innovation on health information technology (HIT) and its impact on care delivery and payment reform, and the Health Information and Management Systems Society panel discussed its quality initiatives and the impact they have on primary care.
  • Regulatory staff attended the CPT Editorial Panel Meeting in Rosemont, IL, where potential changes to CPT coding were discussed.
  • Regulatory staff presented on the 96-hour rule at the ACS Rural Surgery Symposium in Chicago.

Coding Corner

Two Remaining: ACS Surgical Coding Workshops and ICD-10 Preparedness

Two ACS Current Procedural Terminology (CPT) surgical coding workshops are scheduled for the remainder of 2014.

Nashville, TN

Loews Vanderbilt Hotel

Aug. 20–22

800-336-3335

Chicago, IL

Hyatt Chicago Magnificent Mile

Nov. 12–14

888-591-1234

These three-day workshops include ICD-10 Training for General Surgery, E/M Coding, Profitable Practice Operations, and Strategy, and Mastering General Surgery CPT Coding. The ICD-10 session focuses on successfully applying the ICD-10 changes. The course uses a systematic approach to deconstructing the ICD-10 book and includes in-depth ICD-10 coding analysis of neoplasms, gastrointestinal conditions, skin lesions, non-healing wounds, and signs and symptoms of various diseases to prepare for the October 2015 ICD-10 transition. Participants also will receive a coding workbook to use for future reference. The general surgery and strategy sessions will emphasize effective billing and collection processes designed to reduce inaccuracies and delayed reimbursements and offer techniques for improving communication and productivity.

Continuing medical education credits are not available for the ICD-10 session; however, attendees may receive a maximum of 6.5 AMA PRA Category 1 Credits™ for each day of participation in the two general surgery CPT coding sessions. Members of the American Association of Professional Coders may earn a maximum of 6.5 credits per day. Register today.

At the State Level

Lawmakers Nix Trauma Legislation in Florida

During the remaining hours of the legislative session, Florida lawmakers added a 105-page amendment to H.B. 7105. The bill, which subsequently did not pass at the end of the session due to House and Senate differences, dealt with the state’s trauma system. The bill would have:

  • Grandfathered three Hospital Corporation of America (HCA)-owned trauma centers into the trauma system while establishing a one-year moratorium on accrediting facilities that would have expired July 1, 2015
  • Capped trauma activation fees at $15,000, another provision that would have expired July 1, 2015
  • Authorized the Department of Health to conduct a full assessment of the trauma system and submit a report to the legislature by February 1, 2015, as well as conduct an annual review of the trauma system service areas to determine their overall effectiveness in providing “uniform care throughout the state”
  • Required each trauma center to post its activation fee in a conspicuous place within the trauma center and in a prominent place on its website

New York Truth in Advertising Legislation

Legislators in New York are considering the Health Care Professional Transparency Act, S.5493 and A.7889, two important bills that would help ensure that patients are properly informed of the credentials of the health care professional who is treating them. These bills require that advertisements for services provided by health care professionals identify the type of professional license and board certification, if applicable, held by the health care professional. In addition, they would require all advertisements to be free from any deceptive or misleading information. To date, more than 70 letters to state legislators have been generated. Take action and support the bill.

Breast Density Deductible Elimination in Connecticut

S.B. 10, a bill in the Connecticut legislature, unanimously passed the House and Senate in May and awaits action from Gov. Dannel P. Malloy (D). The bill prohibits insurers from imposing a deductible for certain breast ultrasound screenings if an initial mammogram has indicated dense breast tissue. In cases where the patient has a high-deductible plan, the deductible or copayment cannot exceed $20.

Medical Liability Legislation in New York

Legislation in New York, A. 1056, would revise the statute of limitations for medical, dental, and podiatric liability actions. The 2.5-year statute of limitations would run from the date the patient discovers the injury. A second bill, S.7130, also creates a date-of-discovery statute of limitations but would prohibit a liability action from being filed more than 10 years after the date of the alleged act.

These bills could lead to large increases in the cost of liability insurance by raising medical liability premiums more than 15 percent, which, in turn, could have a negative impact on physicians and the state’s health care system. Surgeons in New York are encouraged to contact their legislators to oppose these bills.

States Make Progress on Limiting Use of Tanning Devices by Minors

This year, nearly 20 state legislatures introduced bills to regulate the use of tanning beds. So far, seven bills have been signed into law with more possibly passing in the coming weeks. States that have passed such regulations include Alabama, Hawaii, Indiana, Missouri, Nebraska, Pennsylvania, and Washington. The bills range from establishing regulation for the first time, which occurred in Alabama, to banning those under the age of 18 from using tanning devices without a prescription from a physician, which occurred in Hawaii and Washington.

States debating similar bills include Delaware, Iowa, Louisiana, Massachusetts, Michigan, and New Hampshire. If you have questions or would like more information on this legislation, please contact ACS State Affairs at state_affairs@facs.org.

Optometry Scope of Practice Advances in Louisiana Legislature

On May 7, the Louisiana House of Representatives passed H.B. 1065—legislation the College opposes that would expand optometry’s scope of practice to include scalpel and laser surgery and injections.

H.B. 1065 would permit optometrists to:

  • Inject anesthesia into the eyelid for surgical procedures
  • Perform scalpel eyelid surgeries on lesions, cysts, chalazia and pterygia
  • Use lasers for glaucoma—selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT)
  • Perform yttrium aluminum garnet (YAG) posterior capsulotomy
  • Insert needles for paracentesis procedures

The bill has passed both chambers of the legislature and has now moved to Gov. Bobby Jindal (R) for his consideration.

The College is working with its specialty society partners to oppose this legislation, and has sent a letter asking the governor to veto the bill. All Louisiana surgeons are encouraged to send a message to Governor Jindal encouraging him to veto H.B. 1065.

Liability Reform in Missouri

Legislation reinstating caps on noneconomic damages failed in the Missouri Senate before the session ended May 16. H.B. 1173 and S.B. 589 would have removed medical liability from the common law and created a statutory cause of action for medical liability cases. This provision would have granted the legislature the ability to cap noneconomic damages without violating the right to a jury trial. In 2012, the Supreme Court based its decision to strike down Missouri’s caps on this common law/statutory law difference, where common law causes of action violate the state constitution, but statutorily created ones do not. H.B. 1173 passed the Missouri House in March.

Other News of Interest

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  • Send questions or comments about this issue of The ACS Advocate to Chantay P. Moye, Communications Manager, at cmoye@facs.org.